Fatal Strongyloides stercoralis infection in a young woman with lupus glomerulonephritis.

We report a case of fatal Strongyloides stercoralis (S. stercoralis) infection in a 35-year-old female with lupus glomerulonephritis after prolonged steroid therapy. An epidemiological evaluation revealed that our patient originated from a rural area in Bosnia and Herzegovina, which was an endemic region of S. stercoralis infection in the former Yugoslavia. She had severe gastrointestinal and pulmonary symptoms and history of a 13 kg weight loss in 3 months. Histopathological examination of large bowel mucosa showed nematode larvae. Microscopy of stool, sputum and urine samples confirmed S. stercoralis. The diagnosis was delayed because of the low suspicion index, the absence of eosinophilia and non-specific signs of infection, which could be a result of the underlying disease or the effects of corticosteroids. This case highlights the importance of screening for S. stercoralis in patients starting immunosuppressive therapy, especially if they are from endemic areas. Timely diagnosis and therapy could save the patient's life.